Dissertations / Theses on the topic 'Clinical decision making'
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Jensen, Jan L. "Paramedic Clinical Decision Making." BMC Emergency Medicine, 2009. http://hdl.handle.net/10222/12738.
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Paramedics are responsible for the care of patients requiring emergency assistance in the out of hospital setting. These health care providers need to make many decisions during the course of an emergency call. This thesis on paramedic clinical decision-making includes two studies, intended to determine which decisions paramedics make that are most important for patient safety and clinical outcome, and what thinking strategies paramedics rely on to make decisions. Forty-two decisions were found to be most important for outcome and safety. The highest decision density of an emergency call is during the on-scene treatment phase. Paramedics use a mix of thinking strategies, including rule out worst scenario, algorithmic, and exhaustive thinking. The results of these studies have implications for future research, paramedic practice and training.
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Wong, Thomas Kwok Shing. "Clinical decision making in nursing." Thesis, Glasgow Caledonian University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.283692.
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Gurbutt, Russell. "Demonstrating nurses' clinical decision-making." Thesis, University of Central Lancashire, 2005. http://clok.uclan.ac.uk/21842/.
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The study answers the question: 'How can nurses' properly considered decisions relating to patient care be demonstrated?' Nurses in the United Kingdom have a professional requirement to demonstrate': the properly considered clinical decisions relating to patient care' (UKCC, 1994; NMC, 2002). However, their decisionmaking has been reported as complex and poorly understood, and apart from nursing records, little evidence exists to demonstrate their decisions. The development of the nurses' role as a decision-maker is traced from an origin in Nightingale's text (1860) through to the present day. This role is shaped by organisational, nursing and medical profession influences. Having established that nurses have a role as decision-makers, a conceptual framework is used to examine different explanations about the decision process, outcome, context and how decisions are made. Before undertaking fieldwork, a survey of nurses' decision-making in general medical and surgical wards was conducted. The findings were compared with the conceptual framework to generate questions and avenues for enquiry. An ethnographic study was undertaken in 1999 - 2000 in four general medical wards in two English provincial NHS Trusts with registered nurses (general). A model of decision-making was developed as a mid range theoretical explanation of how they made decisions. This involved a narrative based approach in which nurses generated an account (narrative) of knowing a patient and used this to identify needs. The patient was known in a narrative through three categories of information: nursing, management and medical. These categories were constructed through nurses' information seeking and processing using a tripartite conceptual lens. These facets correspond to different aspects of the nurse's role as a carer, care manager and medical assistant. The patient is known in three ways in a narrative, as a person to care for, an object to be managed, and as a medical case. An oral tradition surrounded its use, and nursing records were not central to decision-making. The narrative was used to make decisions and influence medical decisions. Once it was established how nurses made decisions, a method was developed to show how they could demonstrate their properly considered clinical decisions relating to patient care. This involved using the narrative based decision-making model as an analytical framework applied to nurse decision narratives. Narrative based decisionmaking offers a development of existing descriptive theoretical accounts and new explanations of some features of the decision process. This particularly includes the use of personal note sheets, the role of judgements and the cycle of communicating the narrative to nurses and its subsequent development as a process of developing an explanation of how the patient is known. Having addressed how nurses can demonstrate their properly considered clinical decisions relating to patient care, conclusions are drawn and implications explored in relation to practice, professional regulation, education and method. Recommendations include a challenge to the assumption about decision-making underpinning existing NMC guidance on recordkeeping, and the need to recognise diversity of decision-making practice across different nursing sub-groups. The narrative revealed nurses' ways of constructing knowing patients and rendering this visible. Nurses' not only have a duty, but also a need, to demonstrate decisions so that they can render visible what it is they are and do.
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Everitt, Sally. "Clinical decision making in veterinary practice." Thesis, University of Nottingham, 2011. http://eprints.nottingham.ac.uk/12051/.
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Aim The aim of this study is to develop an understanding of the factors which influence veterinary surgeons’ clinical decision making during routine consultations. Methods The research takes a qualitative approach using video-cued interviews, in which one of the veterinary surgeon’s own consultations is used as the basis of a semi-structured interview exploring decision making in real cases. The research focuses primarily on small animal consultations in first opinion practice, however small numbers of consultations from different types of practice are included to highlight contextual influences on decision making. Findings The study reveals differences between the way clinical decision making is taught and the way that it is carried out in practice. In comparison to human medicine, decision making in veterinary practice appears to be more a negotiated activity, relying on social context, which takes account of the animals’ and owners’ circumstances, as well as biomedical information. Conclusions Veterinary practice especially that provided for companion animals has similarities with medical practice, however there are also differences caused by the status of the animal; the contrast between predominately fee for service veterinary care and state funded medical provision; and the acceptability of euthanasia as a “treatment” option. Clinical decision making in veterinary practice is affected by a range of factors including the resources of the owner, the value placed on the individual animal and the circumstances in which the decision making takes place. Veterinary surgeons in practice need teaching and evidence based resources to take account of these factors in order to provide the best care to their animal patients. Further sociologically informed research is required to provide a greater understanding of the contextual factors which influence clinical decision making.
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Winfield, Catherine V. "Clinical decision making in district nursing." Thesis, University of Surrey, 1998. http://epubs.surrey.ac.uk/2830/.
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The two studies described here address the question of how District Nurses determine patients' nursing problems and plan care. The theoretical framework for the investigation is derived from Information Processing Theory. A process tracing methodology was used to capture the content of District Nurses' thinking during an assessment visit to a newly referred patient. Data was collected in the natural setting to ensure ecological validity. The assessment visits were tape recorded and immediately following the visit a stimulated recall session was conducted in which the nurse was asked to describe her thinking during the assessment, prompted by the tape recording. This session was itself tape-recorded. Thus two verbal protocols were elicited for each assessment: a visit protocol and a recall protocol. Data were analysed by content analysis. The verbal protocols were assessed to ensure that they met the criteria for validity and reliability of the coding schedules was established using two measures or interrater reliability. The first study sought evidence of hypothetico-deductive reasoning by nurses and describes the type of decisions made by nurses. Although evidence of hypothesis generation and testing was found, nurses' knowledge was found to determine how they interpreted data initially and what data they sought. It was therefore concluded that a model of diagnostic reasoning that focused on cognitive processes alone was insufficient to explain the dynamics of clinical problem solving. The second study, therefore, sought to establish the structure and content of District Nurses knowledge and the cognitive processes they used during an assessment. The results suggest that nurses attend to both clinical and personal phenomena in order to make a judgement about the state of the patient and that their knowledge is organised internally as schema. This provides an explanation of how nurses recognise salient information and determine what further data is required. Four key cognitive activities were identified: search, inference, action and plan. The study concludes by drawing a line of reasoning to show how nurses integrate knowledge and reasoning processes to accomplish clinical problem solving.
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Gil-Herrera, Eleazar. "Classification Models in Clinical Decision Making." Scholar Commons, 2013. http://scholarcommons.usf.edu/etd/4895.
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In this dissertation, we present a collection of manuscripts describing the development of prognostic models designed to assist clinical decision making. This work is motivated by limitations of commonly used techniques to produce accessible prognostic models with easily interpretable and clinically credible results. Such limitations hinder prognostic model widespread utilization in medical practice.
Our methodology is based on Rough Set Theory (RST) as a mathematical tool for clinical data anal- ysis. We focus on developing rule-based prognostic models for end-of life care decision making in an effort to improve the hospice referral process. The development of the prognostic models is demonstrated using a retrospective data set of 9,103 terminally ill patients containing physiological characteristics, diagnostic information and neurological function values.
We develop four RST-based prognostic models and compare them with commonly used classification techniques including logistic regression, support vector machines, random forest and decision trees in terms of characteristics related to clinical credibility such as accessibility and accuracy. RST based models show comparable accuracy with other methodologies while providing accessible models with a structure that facilitates clinical interpretation. They offer both more insight into the model process and more opportunity for the model to incorporate personal information of those making and being affected by the decision.
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Wang, Shicai. "Big tranSMART for clinical decision making." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/33348.
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Molecular profiling data based patient stratification plays a key role in clinical decision making, such as identification of disease subgroups and prediction of treatment responses of individual subjects. Many existing knowledge management systems like tranSMART enable scientists to do such analysis. But in the big data era, molecular profiling data size increases sharply due to new biological techniques, such as next generation sequencing. None of the existing storage systems work well while considering the three 'V' features of big data (Volume, Variety, and Velocity). New Key Value data stores like Apache HBase and Google Bigtable can provide high speed queries by the Key. These databases can be modeled as Distributed Ordered Table (DOT), which horizontally partitions a table into regions and distributes regions to region servers by the Key. However, none of existing data models work well for DOT. A Collaborative Genomic Data Model (CGDM) has been designed to solve all these is- sues. CGDM creates three Collaborative Global Clustering Index Tables to improve the data query velocity. Microarray implementation of CGDM on HBase performed up to 246, 7 and 20 times faster than the relational data model on HBase, MySQL Cluster and MongoDB. Single nucleotide polymorphism implementation of CGDM on HBase outperformed the relational model on HBase and MySQL Cluster by up to 351 and 9 times. Raw sequence implementation of CGDM on HBase gains up to 440-fold and 22-fold speedup, compared to the sequence alignment map format implemented in HBase and a binary alignment map server. The integration into tranSMART shows up to 7-fold speedup in the data export function. In addition, a popular hierarchical clustering algorithm in tranSMART has been used as an application to indicate how CGDM can influence the velocity of the algorithm. The optimized method using CGDM performs more than 7 times faster than the same method using the relational model implemented in MySQL Cluster.
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Ogunsanya, Oluwole Victor. "Decision support using Bayesian networks for clinical decision making." Thesis, Queen Mary, University of London, 2012. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8688.
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This thesis investigates the use of Bayesian Networks (BNs), augmented by the Dynamic Discretization Algorithm, to model a variety of clinical problems. In particular, the thesis demonstrates four novel applications of BN and dynamic discretization to clinical problems. Firstly, it demonstrates the flexibility of the Dynamic Discretization Algorithm in modeling existing medical knowledge using appropriate statistical distributions. Many practical applications of BNs use the relative frequency approach while translating existing medical knowledge to a prior distribution in a BN model. This approach does not capture the full uncertainty surrounding the prior knowledge. Secondly, it demonstrates a novel use of the multinomial BN formulation in learning parameters of categorical variables. The traditional approach requires fixed number of parameters during the learning process but this framework allows an analyst to generate a multinomial BN model based on the number of parameters required. Thirdly, it presents a novel application of the multinomial BN formulation and dynamic discretization to learning causal relations between variables. The idea is to consider competing causal relations between variables as hypotheses and use data to identify the best hypothesis. The result shows that BN models can provide an alternative to the conventional causal learning techniques. The fourth novel application is the use of Hierarchical Bayesian Network (HBN) models, augmented by dynamic discretization technique, to meta-analysis of clinical data. The result shows that BN models can provide an alternative to classical meta analysis techniques. The thesis presents two clinical case studies to demonstrate these novel applications of BN models. The first case study uses data from a multi-disciplinary team at the Royal London hospital to demonstrate the flexibility of the multinomial BN framework in learning parameters of a clinical model. The second case study demonstrates the use of BN and dynamic discretization to solving decision problem. In summary, the combination of the Junction Tree Algorithm and Dynamic Discretization Algorithm provide a unified modeling framework for solving interesting clinical problems.
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Miller, Jaclyn Nieman. "Dreaming and decision-making." Case Western Reserve University School of Graduate Studies / OhioLINK, 1991. http://rave.ohiolink.edu/etdc/view?acc_num=case1055519665.
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Burnett, Thomas. "Bayesian decision making in adaptive clinical trials." Thesis, University of Bath, 2017. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.760912.
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The key original contribution of this work is the use of a Bayes optimisation framework for the decision made at the interim analysis of Adaptive Enrichment trials. Adaptive Enrichment designs make efficient use of pre-identified patient sub-populations. They begin by recruiting from all eligible patients, then at a pre-planned interim analysis select which sub-populations will be recruited from for the remainder of the sample. We ensure strong control of the Familywise Error Rate whichever sub-populations are selected by constructing an overall hypothesis testing structure using both closed testing procedures and combination tests. This allows us to make interim decision by any method we choose. We find the Bayes optimal decision, recruiting the remainder of the trial to optimise the Bayes expected gain of the trial. We compare the Bayes optimal Adaptive Enrichment trials with fixed sampling designs to understand the overall advantage of using adaptive trials. This optimisation framework is very flexible, we evaluate the performance of Bayes optimal Adaptive Enrichment designs for different forms of data: delayed responses, longitudinal analysis and discuss the extension of these methods to survival data. Through this we see that although the information at the interim analysis is reduced the adaptive trials still offer some benefit. Additionally we investigate what may happen when we alter the pattern of recruitment of the Adaptive Enrichment trials, showing that adaptation may be useful in a broad range of scenarios.
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Jenkins, Melissa M. Youngstrom Eric Arden. "Clinical decision-making and pediatric bipolar disorder." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2009. http://dc.lib.unc.edu/u?/etd,2745.
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Thesis (M.A.)--University of North Carolina at Chapel Hill, 2009.Title from electronic title page (viewed Mar. 10, 2010). "... in partial fulfillment of the requirements for the degree of Master of Arts in the Department of Psychology Clinical Psychology." Discipline: Psychology; Department/School: Psychology.
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Parker-Tomlin, Michelle. "Clinical Decision Making for Interprofessional Collaborative Practice." Thesis, Griffith University, 2019. http://hdl.handle.net/10072/387381.
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Objective: Interprofessional collaborative practice skills and the ability to make effective clinical decisions are among the most important skills required for practising health professionals, and are an important focus of health discipline students’ training. Individual differences can affect decision making style (e.g., Appelt, Milch, Handgraaf & Weber, 2011; Hewes, 2009; Phillips, Fletcher, Marks, & Hine, 2016; Shaban, 2005), and cognitive processes that use decision making heuristics are prone to biases by both expert and novice clinicians (Bradley, 2005). Therefore, errors and biases could affect the successful interprofessional functioning of healthcare teams. Understanding individual health practitioners’ and students’ natural cognitive processing style, decision making style, and factors that influence these, could be key to researching methods of enhancing clinical decision making (CDM). Considerable evidence supports the positive benefits of healthcare practitioners engaging in interprofessional collaborative practices (IPCP) for patients, clients, and consumers (Morgan, Pullon, & McKinlay, 2015; Sexton, 2016). This includes interprofessional education (IPE) and interprofessional practice development (Barr, Freeth, Hammick, Koppel, & Reeves, 2006; Blue & Garr, 2007; Curran, Sharpe, Flynn, & Button, 2009, (McAllister, Morrissey, Davidson, McAuliffe, McConnell, & Reddy, 2011, Mickan, Hoffman, & Nasmith, 2010; Morgan, Pullon, & McKinlay, 2015, Sexton, 2016). Being able to make optimal clinical decisions and the ability to communicate and collaborate around clinical decisions with other team members, consumers and their families is paramount to successful healthcare. These core IPCP processes are also considered to be extremely important components of contemporary interprofessionalism.
This thesis comprises a series of published and under review papers, that provide a critical analysis of cognitive continuum theory (CCT), and which examines a selective number of individual difference factors with clear theoretical relevance to explore natural processing and decision--making styles in student and health practitioner samples. The CCT theoretical framework is explored as a decision--making orientation strategy in IPE. To further examine CCT’s influence on health practitioner, student, and simulated healthcare teams’ clinical decision making, this thesis assesses the extent to which IPE training can optimally orientate such decision making. CCT requires a precise language to describe both the type of task under consideration, and decision--making methods employed. This research also examines the feasibility of IPE workshops and their potential for providing a platform for healthcare teams to communicate and collaborate around clinical decisions, specifically, CCT’s ability to control for individual differences in cognitive processing, and natural decision--making style.
Method: One critical analysis and two research studies were conducted. The critical analysis explored CCT as a model of human judgment and decision making with the potential to orientate decision--making processes. The critical review specifically examined current applications of CCT and its potential use to a wider range of interprofessional healthcare team processes, including implications for future research, education, practice and policy. The two research studies assessed individual novice––expert health practitioner and interprofessional team decision--making, and components of interprofessional practice (IPP; communication and collaboration) through IPE.
Study 1 explored key variables used to assess individual differences in cognitive processing and decision--making styles. Theoretically relevant factors that the literature indicated as having significant influences were examined. These include the amount of discipline education, clinical experience, IPE, IPP experience, age, personality, and interpersonal motivations, as well as natural decision--making and cognitive processing styles on intuitive, analytic, rational, and experiential continua. A convenience sample (N = 229) current Australian--based healthcare practitioners, and students enrolled in tertiary related health programs, completed an online survey. Respondents were classified as either novices (n = 73), intermediate (n = 85), or expert (n = 71) in their discipline (dental/oral health, dietetics/nutrition, exercise physiology, human service/social work, medicine, midwifery, nursing, occupational therapy, pharmacy, physiotherapy, podiatry, psychology, speech & language pathology).
Study 2 explored the feasibility of using CCT as a decision--making orientation strategy within IPE workshops using a cross--sectional design and an independent convenience sample (N = 33) of health professionals. Using a randomized control method with student participants, this research compared collaborative practice in workshops with the decision--making orientation strategy (CCT workshop) with another already well--established IPE multi--disciplinary mental health (MDMH) workshop (Morrissey, Davidson, McAuliffe, McAllister, McConnell & Reddy, 2011). A convenience sample of 43 students was randomly assigned to either the MDMH or the CCT workshop. In addition, this research also examined the CCT model in a series of workshops with 33 practising health professionals. In summary workshop totals included professional workshops (n = 33), CCT student workshops (n = 23), and MDMH student workshops (n = 20). This format enabled the workshop content and processes in part 1 (CCT or MDMH) to be examined within student interprofessional groups while part 2 also compared CCT suitability for students and professional practitioner populations.
Results: The analysis identified applying CCT as having the potential to improve both individual health practitioner, and interprofessional team understanding about, and communication of, CDM processes. It highlighted the need for further research using the CCT framework before extending its widespread deployment within healthcare sectors. The studies added to the literature with respect to critically appraising a CDM orientation strategy. Study 1 expanded understanding of the complexity of examining natural cognitive processing and decision--making styles, and factors influencing these. Study 2 examined IPP through IPE, and the feasibility of CCT’s application to improve and orientate CDM and interprofessional teams’ communication and collaboration. The critical review concluded that, by guiding decision--making, a CCT framework can potentially provide a useful application in interprofessional healthcare education around CDM. The findings from Study 1 highlighted that research into cognitive processing and decision--making styles yielded inconsistent and contradictory results, which were challenging to interpret, and that were inevitably sample specific. These findings were demonstrated even when research was conducted using a systematic theory--driven approach. Study 2 examined CCT as an IPE tool and usefully added to the literature with respect to the benefits of encouraging IPP through IPE and interprofessional learning in tertiary education and continuing professional development.Thesis (PhD Doctorate)
Doctor of Philosophy in Clinical Psychology (PhD ClinPsych)
School of Applied Psychology
Griffith Health
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Smith, Laurie Ann Johnson. "Clinical decision making capacity among institutionalized elders." Thesis, The University of Arizona, 1993. http://hdl.handle.net/10150/278392.
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A descriptive study was conducted to explore the relationship among three measures of decision making capacity: (1) clinicians' opinions, (2) Pfeiffer's (1975) SPMSQ, and (3) a developmental instrument by Fitten et al. (1990) designed to measure patient clinical decision making ability. Another purpose of the study was to replicate portions of the work by Fitten et al. (1990). A convenience sample of 41 patients, four physicians, and three nurse practitioners was studied. Quantitative research techniques were employed for data collection and analysis. Significant correlations were found among all measurements of decision making capacity indicating that the developmental instrument appears to be a valid method of determining decision making capacity according to results obtained for convergent validity. The findings of this study support those reported by Fitten et al. (1990).
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Kinnaman, Mary Louise Wilson Thad. "Exploring the clinical decision-making strategies of nurses." Diss., UMK access, 2006.
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Thesis (Ph. D.)--School of Nursing. University of Missouri--Kansas City, 2006."A dissertation in nursing." Advisor: Thad Wilson. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed Jan. 29, 2007. Includes bibliographical references (leaves 213-230). Online version of the print edition.
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Bouma, Berto Jorrit. "Clinical decision making in elderly with aortic stenosis." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2005. http://dare.uva.nl/document/78202.
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Meeks-Sjostrom, Diana. "Clinical decision-making of nurses regarding elder abuse." unrestricted, 2008. http://etd.gsu.edu/theses/available/etd-04302008-123109/.
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Thesis (Ph. D.)--Georgia State University, 2008.Title from file title page. Cecelia Gatson Grindel, committee chair; Anne Koci, Annette Bairan, committee members. Electronic text (144 p. : ill.) : digital, PDF file. Description based on contents viewed July 10, 2008. Includes bibliographical references (p. 82-86).
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Meeks-Sjostrom, Diana J. "Clinical Decision-Making of Nurses Regarding Elder Abuse." Digital Archive @ GSU, 2008. http://digitalarchive.gsu.edu/nursing_diss/8.
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A descriptive correlational design based on an adapted model of Donabedian’s Structure, Process, Outcome model and Benner’s Novice to Expert theory was used to examine the clinical decision-making of nurses regarding elder abuse. The relationship of the nurses applied knowledge (assessment cues) of elder abuse; demographic questions (e.g. years of experience as a Registered Nurse (RN) and their clinical level of practice status), the use of intuition in nursing practice; and clinical decision outcomes (interventions) for patients in cases of suspected elder abuse was examined. A convenience sample of RNs who worked in the emergency department (ED) in three acute care hospitals, in southeastern United States were asked to complete questionnaires on education about elder abuse, their intuition use, demographic information, applied knowledge of elder abuse, and clinical decision outcomes for suspected elder abuse. The majority of the nurses had participated in the clinical level of practice status program.The convenience sample of 84 RNs consisted of 68 females (81%) and 16 males (19%). The average age of the respondents was 41.43 years. The mean number of years worked as a RN was 13.87 years. Multiple regression results indicated an overall model of two predictors (RNs applied knowledge (assessment cues) and years worked as a RN) significantly predicted clinical decision outcomes (interventions). The model accounted for 25.1% variance in clinical decision outcomes. The t-test revealed there was no difference (applied knowledge (assessment cues) of elder abuse, intuition use in nursing, years working as a RN, clinical level of practice status, and clinical decision outcomes (interventions)) between RNs who received elder abuse education at orientation and those who did not receive the education. The study results suggest that years of working as a nurse supported elder abuse recognition and intervention. The clinical level of practice status of nurses was found not to be a sensitive indicator. Elder abuse education during orientation varied between the hospital settings. The results indicate the educational need for nurses regarding suspected elder abuse.
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Edwards, Lucy. "Clinical psychologists' decision-making processes during therapy assessment." Thesis, Canterbury Christ Church University, 2002. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.744235.
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Williams, A. Lynn, Jan Edwards, Benjamin Munson, Amy Glaspey, and Shelley Velleman. "Assessment of Speech Sound Disorders: Clinical Decision Making." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/2055.
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This session is developed by, and presenters invited by Speech Sound Disorders in Children. A case-based approach will be used to assess the complexity of SSD through assessment and analysis measures that guide clinical decisions regarding differential diagnosis, intervention planning, and progress monitoring.
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Giere, Sheila S. "A Method for Knowledge Engineering in Clinical Decision Making." DigitalCommons@USU, 1989. https://digitalcommons.usu.edu/etd/5989.
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The purpose of this study was to validate the problem behavior evaluation section of an expert system computer program, Class.BO. Class.BO was developed to assist special education personnel in determining whether students qualify for special education services as behaviorally disordered/severely emotionally disturbed students.
The subjects were six Utah who regularly individuals from the state of 1) work with behaviorally disordered/severely emotionally disturbed students and 2) participate in multidisciplinary assessment teams. Three of the subjects were special educators, and three were school psychologists.
Specifically, this study investigated the impact of five behavioral factors on the subjects' ratings of the seriousness of problem behaviors. The five behavioral factors were 1) the severity or nature of the problem behavior, 2) the frequency with which the problem behavior occurs, 3) the duration over which the problem behavior has been occurring, 4) the generality of the problem behavior or the number of school environments the behavior occurs in , and 5) the percentage of the student's peers who engage in the same behavior. For each behavioral factor, three levels of that factor were determined: high, moderate, and low. Problem behavior descriptions were developed by the researcher, each of which presented the five behavioral factors at a predetermined combination of levels. Of 65 problem behavior descriptions, 3 3 described externalized problem behaviors and 32 described internalized problem behaviors. Subjects were asked to rate the seriousness of each problem behavior description on an 11 point scale, where l=mild and ll=severe.
The results showed high levels of agreement among subjects on ratings of seriousness of problem behaviors. There was also high agreement between the subjects' ratings and ratings generated by the Class.BO expert system. Thus, Class. BD was validated. Further, the subjects gave highly similar ratings to descriptions of externalized and internalized problem behaviors.
The results also indicated that the severity of the problem behaviors had the most impact on subjects' ratings. Subjects discriminated three levels of severity but only two levels of frequency, duration, generality, and percentage of peers.
Finally, the results provided support for the use of analysis of variance as a viable method of knowledge engineering, i.e., extracting information about how experts make decisions. Its superiority over traditional interview methods is discussed.
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Pugh, Dale M. "A phenomenological study of clinical decision making by flight nurse specialists in emergency situations." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1999. https://ro.ecu.edu.au/theses/1249.
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Clinical decision making is an integral, multifaceted phenomenon fundamental to nursing practice. The domain of flight nursing practice is unique in terms of knowledge, structure, clinical presentations and environment. The uniqueness and diversity of patient scenarios and the advanced practice level of the flight nurse role blend to provide a potential rollercoaster flight mission. At the time this research was conducted nursing standards to guide clinical decision making were being developed. Medically orientated clinical guidelines were in place, but they were designed to highlight a specific, well defined clinical scenario or skill. It has been argued that guidelines for nursing practice do not always parallel the complex clinical situations in which advanced practitioners may find themselves (Malone, 1992b). Flight Nurse Specialists (FNSs) with greater than two years flight nursing experience employed by the Royal Flying Doctor Service (RFDS) - Western Operations were interviewed regarding their experiences of clinical decision making in emergency situations. Using a phenomenological methodology, indepth interviews were audiotaped and transcribed. The interviews were analysed using the method described by Colaizzi (1978). Data was described and interpreted, common themes were extrapolated and analysed. A Gestalt of Knowing was identified by the interconnection and interrelationships of the extrapolated themes. The three themes are: Ways of Knowing the Patient, Context of Knowing and Reflective Practice. Ways of Knowing the Patient is constructed with the sub-themes intuitive knowing, experiential knowing and objective knowing. The second theme, Context of Knowing, is made up of the sub-themes aviation environment, non or minimised involvement in triage, knowing co11eagues, solo practitioner, experiential level and practice guidelines. Self-critique and change in practice formed the theme Reflective Practice. Findings provide a significant contribution to the knowledge of clinical decision making in nursing and to the practice of flight nursing in the Western Australian context. Several recommendations arose from the findings in relation to further research, policy making, standards development and practice developments. Further research is needed into the themes and sub-themes. FNSs need to be allowed to undertake the role of triage for those flights that they will undertake as the solo health professional. The development of standards for flight nursing would benefit from the consideration of the findings of this study and other qualitative studies of clinical decision making. Reflective practice should be considered as a mechanism for not only evaluating practice but as a mechanism for identifying stressful events.
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McCleary, Nicola. "Relationships between perceived decision difficulty, decision time, and decision appropriateness in General Practitioners' clinical decision-making." Thesis, University of Aberdeen, 2015. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=229003.
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The aim of this project was to use patient scenarios (clinical/case vignettes) to explore three aspects of General Practitioners' (GPs') clinical decision-making: how difficult decisions are perceived to be, the time taken to make decisions, and the appropriateness of decisions relative to evidence-based clinical guideline recommendations. A systematic review synthesised the results of published scenario studies. A secondary analysis of scenario studies which investigated antibiotic prescribing for upper respiratory tract infection (URTI) and x-ray referral for low back pain was performed. Relationships between the three aspects of decision-making were investigated, and scenario and GP characteristics associated with these aspects were identified. An online scenario study further refined these relationships for two specific URTI types: sore throat and otitis media. Cognitive processes involved in clinical decision-making were investigated in a Think-Aloud interview study, where GPs verbalised their thoughts while making prescribing decisions for URTI scenarios. There was some evidence that inappropriate antibiotic prescribing for URTI was associated with greater decision difficulty and longer decision time. Decisions made using a more effortful cognitive process may therefore be less likely to be appropriate. Illness durations of four or more days and, in otitis media, unilateral ear examination findings were related to inappropriate prescribing. Based on these results, suggestions have been made for informing the design of interventions to support GPs in making appropriate decisions. A secondary aim was to provide an overview of the methodology and reporting of scenario studies. The systematic review indicated a lack of consistency in methodologies, while reporting is often inadequate. Formats less similar to real consultations (e.g. written scenarios) are commonly used: the results of studies using these formats may be less likely to reflect real practice decision-making than studies using more realistic formats (e.g. videos). Based on these findings, methodological recommendations for scenario studies have been developed.
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Black, Margaret Elizabeth. "Student nurses' clinical decision-making, key to professional practice." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp02/NQ27764.pdf.
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Abhyankar, Purva. "Decision making about cancer treatment and clinical trial participation." Thesis, University of Leeds, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.493567.
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Informed decision making is essential for clinical trial participation. As few studies have explored patients' decision making about trial participation, this thesis draws on theories and methods from behavioural decision research and health psychology to investigate decision making about trial participation in the context of treatment for breast and ovarian cancer.
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Joshua, Beverly. "Nursing students' approaches to learning and clinical decision-making." Thesis, London South Bank University, 2017. http://researchopen.lsbu.ac.uk/1840/.
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The present and categorical correspondence between how students approach their learning and the way such approaches impact on the acquisition and augmentation of clinical decision-making skills is neither well understood, nor yet clearly established, in nurse education research. To address this gap, this study investigated the approaches to learning and the clinical decision-making of adult nursing students in their final year of training on two separate campuses of a central London university. Approaches to Learning Theory, promulgated by Martin and Sӓljö in 1976, and subsequently expanded and updated by Entwistle and colleagues, provided a theoretical lens and explanatory framework for this study. Acknowledging that the Approaches to Learning Theory adopts a hierarchy of three domains of approach, surface, strategic, and deep, it is argued that students’ clinical decisionmaking should be improved by changing their predominant approach to learning from the surface or strategic to the deep approach. To test this hypothesis, a research intervention was implemented for a purposive sample of participants who adopted either the surface or strategic approach to learning. Consistent with the underpinning principles of the deep approach to learning, the intervention focused on enhancing engagement with learning, problem-solving, and critical thinking skills. A second survey of approaches to learning and clinical decision-making was administered after the intervention, and semi-structured interviews were conducted to further corroborate the statistical findings. Instruments for data collection comprised the Approaches to Study Skills Inventory for Students, known as the ASSIST (Tait et al, 1998), Jenkins’ (1985) Clinical Decision-making Nursing Scale (CDMNS), and a short demographic questionnaire designed by the researcher. This research found that by altering the learning approach, consequent on the researchintervention, the adoption of the deep approach to learning enhanced clinical decision-making. Post-intervention findings revealed a strong positive correlation between the deep approach and clinical decision-making. Participants’ disposition for the surface approach also decreased significantly. Male participants indicated an affinity for the deep approach in comparison to female students who predominantly adopted the strategic approach. The study concluded that by cultivating students’ deeper engagement, underpinned by the intention to seek meaning and understand their learning, clinical decision-making was improved.
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Clark, Rebecca Culver. "Clinical decision making by beginning nurses: a naturalistic study." Diss., Virginia Tech, 1996. http://hdl.handle.net/10919/37767.
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Rojas, Cordova Alba Claudia. "Resource Allocation Decision-Making in Sequential Adaptive Clinical Trials." Diss., Virginia Tech, 2017. http://hdl.handle.net/10919/86348.
Full textAbstract:
Adaptive clinical trials for new drugs or treatment options promise substantial benefits to both the pharmaceutical industry and the patients, but complicate resource allocation decisions. In this dissertation, we focus on sequential adaptive clinical trials with binary response, which allow for early termination of drug testing for benefit or futility at interim analysis points. The option to stop the trial early enables the trial sponsor to mitigate investment risks on ineffective drugs, and to shorten the development time line of effective drugs, hence reducing expenditures and expediting patient access to these new therapies. In this setting, decision makers need to determine a testing schedule, or the number of patients to recruit at each interim analysis point, and stopping criteria that inform their decision to continue or stop the trial, considering performance measures that include drug misclassification risk, time-to-market, and expected profit. In the first manuscript, we model current practices of sequential adaptive trials, so as to quantify the magnitude of drug misclassification risk. Towards this end, we build a simulation model to realistically represent the current decision-making process, including the utilization of the triangular test, a widely implemented sequential methodology. We find that current practices lead to a high risk of incorrectly terminating the development of an effective drug, thus, to unrecoverable expenses for the sponsor, and unfulfilled patient needs. In the second manuscript, we study the sequential resource allocation decision, in terms of a testing schedule and stopping criteria, so as to quantify the impact of interim analyses on the aforementioned performance measures. Towards this end, we build a stochastic dynamic programming model, integrated with a Bayesian learning framework for updating the drug’s estimated efficacy. The resource allocation decision is characterized by endogenous uncertainty, and a trade-off between the incentive to establish that the drug is effective early on (exploitation), due to a time-decreasing market revenue, and the benefit from collecting some information on the drug’s efficacy prior to committing a large budget (exploration). We derive important structural properties of an optimal resource allocation strategy and perform a numerical study based on realistic data, and show that sequential adaptive trials with interim analyses substantially outperform traditional trials. Finally, the third manuscript integrates the first two models, and studies the benefits of an optimal resource allocation decision over current practices. Our findings indicate that our optimal testing schedules outperform different types of fixed testing schedules under both perfect and imperfect information.Ph. D.
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Mohr, Peggy, and Kara Boynewicz. "Team-Based Learning: Clinical Decision-Making Across the Lifespan." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/8351.
Full textAbstract:
Join your colleagues for dynamic group discussions about best practice in pediatric physical therapy. Attendees will participate in Team-Based Learning activities, sharing their knowledge, experiences, and skills, to problem-solve and come to a team consensus on clinical decisions. Participants will review a case study that is designed to address pediatric therapy across the lifespan, incorporate multiple practice areas, and stimulate critical thinking. Team-Based Learning is an instructional strategy that uses a set of structured activities to create active, energetic, collaborative learning environments. Information designed to support individuals’ ability to participate in the activities and clinical decision-making will be provided prior to APPTAC to those registered for the session. This session will take place in multiple rooms.
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Thomson, Oliver. "Clinical decision making and therapeutic approaches of experienced osteopaths." Thesis, University of Brighton, 2013. https://research.brighton.ac.uk/en/studentTheses/c1120835-e2e7-46c7-82c2-364a1facf1d2.
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Clinical decision-making refers to the social, cognitive and interactive processes by which practitioners make choices in relation to the examination, diagnosis, treatment and management of patients. It is fundamental for effective and efficient clinical practice and is central to professional autonomy and accountability. As the profession continues to grow, osteopathy is playing an increasingly important role in musculoskeletal healthcare. While research has identified the clinical decision-making approaches taken by a range of healthcare professions, there is limited understanding of how osteopaths make decisions in relation to clinical practice. The aim of this research was to construct an explanatory theory of the clinical decision-making and therapeutic approaches of experienced osteopaths in the UK.
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Boland, Laura. "Implementation of Shared Decision Making in Pediatric Clinical Practice." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38181.
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Shared decision making (SDM) is rarely used in pediatric clinical practice. The purpose of this dissertation was to explore factors influencing SDM implementation in pediatric clinical practice. We conducted three studies that were guided by the Ottawa Model of Research Use (OMRU):
Study 1 was a systematic review using Cochrane methods and the Mixed Methods Appraisal Tool to determine pediatric SDM barriers and facilitators from multiple perspectives. Eighty studies, of low to high quality, were included. At each OMRU level, frequently cited barriers were: option features (decision), poor quality information (innovation), emotional state (adopter), power relations (relational), and insufficient time (environment). Frequently cited facilitators were: lower stake decisions (decision), agreement with SDM (adopter), high quality information (innovation), trust and respect (relational), and SDM tools/resources (environment). Across participant types, frequently cited barriers were: insufficient time (healthcare providers (HCP)), option features (parents), power imbalances (children), and HCPs’ SDM skills (observers). Frequently cited facilitators were: good quality information (HCPs) and agreement with SDM (parents/children).
Study 2 was a post-test design that evaluated SDM knowledge and acceptability of learners who completed the Ottawa Decision Support Tutorial (ODST). Most learners were HCPs (62%). Overall, ODST learners had a median knowledge test score of 8/10 (IQR = 7-9; n=6604) and 90% reported good or excellent impressions (n=4276) after completing the tutorial. Few learners suggested improvements.
Study 3 used mixed methods to evaluate pediatric HCPs’ perceived SDM barriers and facilitators after training (ODST plus workshop). Participants completed a SDM barrier survey (n=60; 88% response rate) and semi-structured interview (n=11). Their intention to use SDM was high (mean score = 5.6/7, SD=0.8). However, 90% of respondents reported minimal SDM use after training. Main barriers were lack of buy-in (adopter level) and time constraints (environmental level). Healthcare providers wanted a team-based approach to SDM training (training level).
Adopters face numerous and diverse barriers to SDM use, before and after SDM training. Pediatric HCPs who completed the ODST were knowledgeable about SDM. Despite positive intentions, training alone was insufficient to achieve routine SDM use. These findings can inform intervention development to promote SDM implementation in pediatric clinical practice.
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Lulloff, Amanda J. "Nutrition Related Clinical Decision Making of Pediatric Oncology Nurses." Thesis, Boston College, 2018. http://hdl.handle.net/2345/bc-ir:107898.
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Thesis advisor: Judith A. VesseyPurpose: The purpose of this study is to investigate staff nurses’ clinical decision making (CDM) regarding pediatric oncology patients’ nutritional status. Background: Malnutrition, both under- and over-nutrition, in children can lead to significant morbidity and even mortality. Pediatric cancer patients are at high risk for malnutrition secondary to the disease process and treatment side effects; malnutrition in pediatric oncology patients is associated with poorer outcomes. Pediatric oncology nurses, with frequent and consistent contact with patients, are in an ideal position to assess nutritional status. Early identification and intervention for nutritional concerns in patients has been shown to improve outcomes. However, research on the quality of pediatric oncology nurses’ CDM regarding nutritional status does not exist. Methods: A web-based survey was distributed to members of the Association of Pediatric Hematology Oncology Nurses; it was comprised of three sections: a demographic data collection form, pediatric oncology nutrition related vignettes, and the New General Self-Efficacy Scale. The vignettes were rated on a one to five scale with one being under-nourished and 5 being over-nourished. Participants were asked to report their confidence in their rating and select cues in the vignette supporting the rating. A multi-level regression analysis was utilized to assess the quality of nurses’ CDM, the confidence of the nurses’ CDM, and the factors associated with CDM. Results: No nurse or organizational factors could be identified as useful in predicting the accuracy of the participants’ nutritional rating; however, nurses were significantly likely to under-rate the vignette when comparted with the expert panel’s rating. Nurses were significantly likely to select fewer cues supportive of nutritional rating than the expert panel. Conclusions: Further research regarding nutritional assessment and nurses’ clinical decision making is warranted. Evidence-based guidelines for nutritional assessment of pediatric oncology patients should be developed and implemented to ensure this patient population receives the highest quality of care
Thesis (PhD) — Boston College, 2018
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Ghersi, Davina. "Issues in the design, conduct and reporting of clinical trials that impact on the quality of decision making." Phd thesis, School of Public Health, 2006. http://hdl.handle.net/2123/6653.
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Higuchi, Kathryn A. Smith. "Professional nursing education : cognitive processes utilized in clinical decision making." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/NQ44452.pdf.
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Stone, Tracey Jayne. "Rationality, informed consent and patient decision making for clinical trials." Thesis, University of Bristol, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.509761.
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Forristal, Kaitlyn Michelle Forristal. "Fatphobia and Clinical Counseling Decision Making in Counselor Education Students." University of Toledo / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1533206025226826.
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Kelly, Joan. "Clinical decision-making in the management of whiplash associated disorders." Thesis, Griffith University, 2018. http://hdl.handle.net/10072/381534.
Full textAbstract:
This thesis investigates various aspects of clinical decisionOmaking in the management
of individuals with acute whiplash associated disorders (WAD), with a primary focus on
physiotherapy professionals and one available clinical prediction rule designed for the
purpose of guiding prognostic judgments (the Whiplash CPR). WAD is a prevalent and
frequently chronic condition that is associated with substantial personal and societal
cost. It is currently challenging for healthcare practitioners to manage, as
heterogeneity in the population and nil to small effect sizes from clinical trials mean
that deciding on the best course of action may be difficult. Early and accurate
identification of prognostic risk has the potential to lessen current rates of progression
to chronic WAD, by enabling the provision of stratified care to more homogeneous
groups of individuals.
This body of work comprises a series of four studies using mixed methods. Study 1
comprised a systematic review of clinical prediction rules that relate to prognostic and
treatment decisionOmaking for the conservative management of neck pain. The study
was necessary in identifying available tools, and appraising stage of development,
quality and readiness for application, with the ultimate purpose of assisting healthcare
practitioners in the evaluation and selection of an appropriate tool for use in clinical
practice. Two independent reviewers assessed the eligibility, risk of bias,
methodological quality and stage of development of studies identified from a
systematic search of six databases. The results indicated that three out of nine
identified prognostic clinical prediction rules specific to acute WAD are at a stage of
development that lends support to clinical use. Use of the Whiplash CPR selected as
the focus of this thesis, was supported by maintenance of accuracy on validation, and
the satisfaction of most methodological quality criteria used in the review.
Study 2 focused on the Whiplash CPR and sought to assess its potential clinical utility.
A pragmatic crossOsectional design was used to investigate the level of agreement between physiotherapist estimatedO and Whiplash CPR classifiedO prognostic risk for
adults who presented to a participating physiotherapist (n=24) with acute WAD IOIII
(n=38). Agreement was found to be very low (29%, K= O0.03; 95%CI O0.17 to 0.12), and
physiotherapists likely underOidentified individuals at high risk of poor recovery (3%,
n=1/38). The findings of this study indicate that physiotherapists may benefit from
incorporating the Whiplash CPR into usual assessment and decisionOmaking processes
when attempting to gauge patient prognosis.
The presence of a validated, accurate and clinically useful clinical prediction rule, such
as the Whiplash CPR, has not historically ensured widespread use. Study 3 sought to
inform implementation of the Whiplash CPR through qualitative exploration of
healthcare practitioners’ (n=28) awareness and practice behaviours regarding clinical
prediction rules, and perceptions for using the Whiplash CPR in future practice. Six
focus group discussions were conducted, audioOrecorded, transcribed verbatim and
analysed using an inductive thematic approach. Many clinicians considered the
Whiplash CPR to be acceptable to them. Implementation themes including the
provision of an external driver of adoption, flexibility in how the Whiplash CPR could
be accessed and administered, and guidance regarding communication of its output to
patients, were identified as useful in promoting future use.
Finally, Study 4 related to management designed to specifically target individuals
identified by the Whiplash CPR as being at heightened risk of poor recovery. A
qualitative investigation was performed of physiotherapists’ (n=11) experiences of
delivering a novel psychological intervention (Stress Inoculation Training) to this
population as part of a randomised controlled trial. SemiOstructured interviews were
conducted, audioOrecorded, transcribed verbatim, and analysed thematically using a
withinO and acrossOcase strategy. Physiotherapists were found to support adding Stress
Inoculation Training to usual guidelineObased management. The feasibility and use of
the intervention in routine clinical practice were facilitated by confidence in the ability
to deliver the program, viewing it as falling within current scope of practice, and the
ability to selectively deliver the content to meet the needs of individual patients.
The findings of this body of work provide support to existing preliminary evidence that
physiotherapists may experience difficulty differentiating individuals who may and
may not recover from acute WAD. While progress has been made towards the rigorous
development of predictive tools to assist clinicians in this capacity, further validation
and impact analyses of existing models are ultimately required. At present, the
Whiplash CPR appears to be the most robust tool available for use in clinical practice. It
is therefore recommended that clinicians commence incorporating the CPR into
existing prognostic assessment and decisionOmaking processes. Physiotherapists
appear receptive to the using the Whiplash CPR and delivering new management
strategies that target individuals who are at heightened risk of developing chronic
WAD. However, education and support are needed to facilitate widespread changes to practice.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School Allied Health Sciences
Griffith Health
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Dave, Havya, Chase King, Curry Jones, and Amanda Stoltz. "SPIROMETRY AND IMPROVING CLINICAL DECISION MAKING IN REACTIVE AIRWAY DISEASES." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/160.
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At least 11 million Americans are diagnosed with chronic obstructive pulmonary disease (COPD), and there is a high likelihood millions more suffer from the disease but are undiagnosed. Spirometry is a medical test to determine how well a patient’s lungs work, and is used to diagnosis COPD. Despite this test’s utility, resident providers may be uneducated about or uncomfortable with administering spirometry. Past research has demonstrated that brief educational interventions can lead to clinically significant improvements in knowledge of spirometry. The purpose of this study is to compare family medicine residents’ responses regarding the use of spirometry in a rural Family Medicine Residency clinic before and after an educational program on the topic. Researchers will administer a survey to resident physicians at the Family Physicians of Bristol clinic about their knowledge regarding spirometry; residents will then be resurveyed after an educational program. It is expected that resident providers will show significant gains in their knowledge of spirometry after the completion of the educational program. Results of this project will be useful in identifying methods to increase medical providers’ awareness and comfort with spirometry, which will hopefully lead to increased accurate diagnosis of airway diseases.
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Loftus, Stephen Francis. "Language in clinical reasoning: using and learning the language of collective clinical decision making." Thesis, The University of Sydney, 2006. http://hdl.handle.net/2123/1165.
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The aim of the research presented in this thesis was to come to a deeper understanding of clinical decision making from within the interpretive paradigm. The project draws on ideas from a number of schools of thought which have the common emphasis that the interpretive use of language is at the core of all human activity. This research project studied settings where health professionals and medical students engage in clinical decision making in groups. Settings included medical students participating in problem-based learning tutorials and a team of health professionals working in a multidisciplinary clinic. An underlying assumption of this project was that in such group settings, where health professionals are required to articulate their clinical reasoning for each other, the individuals involved are likely to have insights that could reveal the nature of clinical decision making. Another important assumption of this research is that human activities, such as clinical reasoning, take place in cultural contexts, are mediated by language and other symbol systems, and can be best understood when investigated in their historical development. Data were gathered by interviews of medical students and health professionals working in the two settings, and by non-participant observation. Data analysis and interpretation revealed that clinical decision making is primarily a social and linguistic skill, acquired by participating in communities of practice called health professions. These communities of practice have their own subculture including the language game called clinical decision making which includes an interpretive repertoire of specific language tools and skills. New participants to the profession must come to embody these skills under the guidance of more capable members of the profession, and do so by working through many cases. The interpretive repertoire that health professionals need to master includes skills with words, categories, metaphors, heuristics, narratives, rituals, rhetoric, and hermeneutics. All these skills need to be coordinated, both in constructing a diagnosis and management plan and in communicating clinical decisions to other people, in a manner that can be judged as intelligible, legitimate, persuasive, and carrying the moral authority for subsequent action.
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Loftus, Stephen Francis. "Language in clinical reasoning learning and using the language of collective clinical decision making /." Faculty of Health Sciences, School of Physiotherapy, University of Sydney, 2006. http://hdl.handle.net/2123/1165.
Full textAbstract:
Doctor of PhilosophyThe aim of the research presented in this thesis was to come to a deeper understanding of clinical decision making from within the interpretive paradigm. The project draws on ideas from a number of schools of thought which have the common emphasis that the interpretive use of language is at the core of all human activity. This research project studied settings where health professionals and medical students engage in clinical decision making in groups. Settings included medical students participating in problem-based learning tutorials and a team of health professionals working in a multidisciplinary clinic. An underlying assumption of this project was that in such group settings, where health professionals are required to articulate their clinical reasoning for each other, the individuals involved are likely to have insights that could reveal the nature of clinical decision making. Another important assumption of this research is that human activities, such as clinical reasoning, take place in cultural contexts, are mediated by language and other symbol systems, and can be best understood when investigated in their historical development. Data were gathered by interviews of medical students and health professionals working in the two settings, and by non-participant observation. Data analysis and interpretation revealed that clinical decision making is primarily a social and linguistic skill, acquired by participating in communities of practice called health professions. These communities of practice have their own subculture including the language game called clinical decision making which includes an interpretive repertoire of specific language tools and skills. New participants to the profession must come to embody these skills under the guidance of more capable members of the profession, and do so by working through many cases. The interpretive repertoire that health professionals need to master includes skills with words, categories, metaphors, heuristics, narratives, rituals, rhetoric, and hermeneutics. All these skills need to be coordinated, both in constructing a diagnosis and management plan and in communicating clinical decisions to other people, in a manner that can be judged as intelligible, legitimate, persuasive, and carrying the moral authority for subsequent action.
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Palmer, Barbara Benson 1958. "Clinical decision making about end-of-life decisions of persons over 65: Perceptions of clinicians." Thesis, The University of Arizona, 1992. http://hdl.handle.net/10150/278251.
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A descriptive study was conducted to explore whether or not there were any differences in perceptions of physicians, acute care nurses, long-term care nurses, and nurse practitioners associated with end-of-life decision making for people over 65 years of age. A convenience sample of 95 health care providers, all of whom were involved in direct patient care was used. Quantitative research techniques were employed for data collection and analysis. Statistically significant differences were found between four individual items on the CDMS and the health care providers. It was found that long-term care nurses believed items associated with pain and suffering, and culture to be more important than either physicians or acute care nurses, where as they found physicians input less important. A statistical significance was also found between the years spent in practice by health care providers and scores on the CDMS.
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Saunders, Dinah Jo. "Clinical decision-making and clinical judgment outcomes by nursing students in traditional or nontraditional curricula." W&M ScholarWorks, 1997. https://scholarworks.wm.edu/etd/1539618497.
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The purpose of this study was to investigate the claim that nursing students in nontraditional curricula achieve program outcomes consistent with nursing students in traditional generic curricula. Clinical decision making and clinical judgment are essential components of critical thinking in nursing. Self-perception as a decision-maker was measured by the Clinical Decision Making in Nursing Scale (CDMNS) and clinical judgment was measured by the Clinical Judgment in Nursing Series #1: Emergencies in Adult Client Care Test (CJS:EACC).;Participants were recruited from three regional universities. One curricular group consisted of a generic (traditional) BSN group. One nontraditional curricular design was RN-BSN Completion programs designed for RN's to return for degree completion. The second nontraditional curricular group represented an Accelerated BSN program designed for adult learners with a previous baccalaureate degree to achieve a career change to nursing.;No significant outcome differences in self-perception as a clinical decision-maker as measured by mean scores on the CDMNS or in the decision making process as measured by subscale scores on the CDMNS were found between Traditional and nontraditional student groups. The hypotheses that there would be no differences in either self-perception as a decision maker or the decision making process were supported.;A significant difference was found between group scores related to clinical judgment as measured by the CJS:EACC. The nontraditional curricular groups, primarily adult learners, achieved higher scores than the generic group. The attributes of age, work experience, self-directedness, and readiness to learn may have influenced the adult learner's ability to achieve, through nontraditional program structures, at the same level or higher as traditional students. Age was an influencing variable on CJS:EACC scores. The instrument measures nursing assessment and intervention related to adult medical/surgical clients. The hypothesis that there would be no difference in clinical judgment could not be supported.;Interview responses representative of each curricular group were consistent with previous studies of the goals, barriers, learning needs, and characteristics of the adult learner.
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Li, Xiaogai. "Finite Element and Neuroimaging Techniques toImprove Decision-Making in Clinical Neuroscience." Doctoral thesis, KTH, Neuronik, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-72345.
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Our brain, perhaps the most sophisticated and mysterious part of the human body, to some extent, determines who we are. However, it’s a vulnerable organ. When subjected to an impact, such as a traffic accident or sport, it may lead to traumatic brain injury (TBI) which can have devastating effects for those who suffer the injury. Despite lots of efforts have been put into primary injury prevention, the number of TBIs is still on an unacceptable high level in a global perspective. Brain edema is a major neurological complication of moderate and severe TBI, which consists of an abnormal accumulation of fluid within the brain parenchyma. Clinically, local and minor edema may be treated conservatively only by observation, where the treatment of choice usually follows evidence-based practice. In the first study, the gravitational force is suggested to have a significant impact on the pressure of the edema zone in the brain tissue. Thus, the objective of the study was to investigate the significance of head position on edema at the posterior part of the brain using a Finite Element (FE) model. The model revealed that water content (WC) increment at the edema zone remained nearly identical for both supine and prone positions. However, the interstitial fluid pressure (IFP) inside the edema zone decreased around 15% by having the head in a prone position compared with a supine position. The decrease of IFP inside the edema zone by changing patient position from supine to prone has the potential to alleviate the damage to axonal fibers of the central nervous system. These observations suggest that considering the patient’s head position during intensive care and at rehabilitation should be of importance to the treatment of edematous regions in TBI patients. In TBI patients with diffuse brain edema, for most severe cases with refractory intracranial hypertension, decompressive craniotomy (DC) is performed as an ultimate therapy. However, a complete consensus on its effectiveness has not been achieved due to the high levels of severe disability and persistent vegetative state found in the patients treated with DC. DC allows expansion of the swollen brain outside the skull, thereby having the potential in reducing the Intracranial Pressure (ICP). However, the treatment causes stretching of the axons and may contribute to the unfavorable outcome of the patients. The second study aimed at quantifying the stretching and WC in the brain tissue due to the neurosurgical intervention to provide more insight into the effects upon such a treatment. A nonlinear registration method was used to quantify the strain. Our analysis showed a substantial increase of the strain level in the brain tissue close to the treated side of DC compared to before the treatment. Also, the WC was related to specific gravity (SG), which in turn was related to the Hounsfield unit (HU) value in the Computerized Tomography (CT) images by a photoelectric correction according to the chemical composition of the brain tissue. The overall WC of brain tissue presented a significant increase after the treatment compared to the condition seen before the treatment. It is suggested that a quantitative model, which characterizes the stretching and WC of the brain tissue both before as well as after DC, may clarify some of the potential problems with such a treatment. Diffusion Weighted (DW) Imaging technology provides a noninvasive way to extract axonal fiber tracts in the brain. The aim of the third study, as an extension to the second study was to assess and quantify the axonal deformation (i.e. stretching and shearing)at both the pre- and post-craniotomy periods in order to provide more insight into the mechanical effects on the axonal fibers due to DC. Subarachnoid injection of artificial cerebrospinal fluid (CSF) into the CSF system is widely used in neurological practice to gain information on CSF dynamics. Mathematical models are important for a better understanding of the underlying mechanisms. Despite the critical importance of the parameters for accurate modeling, there is a substantial variation in the poroelastic constants used in the literature due to the difficulties in determining material properties of brain tissue. In the fourth study, we developed a Finite Element (FE) model including the whole brain-CSF-skull system to study the CSF dynamics during constant-rate infusion. We investigated the capacity of the current model to predict the steady state of the mean ICP. For transient analysis, rather than accurately fit the infusion curve to the experimental data, we placed more emphasis on studying the influences of each of the poroelastic parameters due to the aforementioned inconsistency in the poroelastic constants for brain tissue. It was found that the value of the specific storage term S_epsilon is the dominant factor that influences the infusion curve, and the drained Young’s modulus E was identified as the dominant parameter second to S_epsilon. Based on the simulated infusion curves from the FE model, Artificial Neural Network (ANN) was used to find an optimized parameter set that best fit the experimental curve. The infusion curves from both the FE simulations and using ANN confirmed the limitation of linear poroelasticity in modeling the transient constant-rate infusion. To summarize, the work done in this thesis is to introduce FE Modeling and imaging technologiesincluding CT, DW imaging, and image registration method as a complementarytechnique for clinical diagnosis and treatment of TBI patients. Hopefully, the result mayto some extent improve the understanding of these clinical problems and improve theirmedical treatments.QC 20120201
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Green, Belinda. "Caesarean birth : the impact of clinical uncertainty on professional decision-making." Thesis, City University London, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.446318.
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Forsyth, Alexander William. "Improving clinical decision making with natural language processing and machine learning." Thesis, Massachusetts Institute of Technology, 2017. http://hdl.handle.net/1721.1/112847.
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Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2017.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 49-53).
This thesis focused on two tasks of applying natural language processing (NLP) and machine learning to electronic health records (EHRs) to improve clinical decision making. The first task was to predict cardiac resynchronization therapy (CRT) outcomes with better precision than the current physician guidelines for recommending the procedure. We combined NLP features from free-text physician notes with structured data to train a supervised classifier to predict CRT outcomes. While our results gave a slight improvement over the current baseline, we were not able to predict CRT outcome with both high precision and high recall. These results limit the clinical applicability of our model, and reinforce previous work, which also could not find accurate predictors of CRT response. The second task in this thesis was to extract breast cancer patient symptoms during chemotherapy from free-text physician notes. We manually annotated about 10,000 sentences, and trained a conditional random field (CRF) model to predict whether a word indicated a symptom (positive label), specifically indicated the absence of a symptom (negative label), or was neutral. Our final model achieved 0.66, 1.00, and 0.77 F1 scores for predicting positive, neutral, and negative labels respectively. While the F1 scores for positive and negative labels are not extremely high, with the current performance, our model could be applied, for example, to gather better statistics about what symptoms breast cancer patients experience during chemotherapy and at what time points during treatment they experience these symptoms.
by Alexander William Forsyth.
M. Eng.
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LoMonaco, Marina Lucia. "Investigation of registered nurses' clinical decision-making processes in aged care." Thesis, Australian Catholic University, 2014. https://acuresearchbank.acu.edu.au/download/82226bdbfa1530c6d8ab4af6a353544c82d3bc780769c21c2f7a712a069d908e/2826137/201404_Marina_LoMonaco__PhD_FINAL_28Feb2015pdf.pdf.
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An ageing global population places increasing humanitarian and financial loads on government, health and welfare agencies; necessitating change and innovation to meet and manage clinical and physically complex needs and demands. Australian residential aged care has been influenced by these international and jurisdictional socio-political forces. This thesis aims to inform healthcare professionals and others about Australian aged care registered nurse (RN) decision-making processes, as well as convey understanding of the responsibilities and contextual influences upon RNs working in this sector and scope of practice according to their professional responsibilities...
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Sehume, Gloria Gaogakwe. "Ethical decision-making the experience of nurses in selected clinical settings /." Diss., Pretoria :b [s.n.], 2008. http://upetd.up.ac.za/thesis/available/etd-05132009-125706.
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Mehdizadeh, Leila. "Doctors' clinical decision making : using theory to develop an educational intervention." Thesis, University of Leeds, 2011. http://etheses.whiterose.ac.uk/15226/.
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Medical education aims to train students to become safe and effective clinical practitioners. This includes the ability to make safe and effective clinical judgements and decisions (GMC 2009). It is assumed that trainee doctors acquire these skills through the hidden curriculum. This is not necessarily the case. There is reason to believe that medical education should include some explicit training for doctors to improve their clinical judgements and decisions. This is known as training in clinical reasoning. This thesis explored how to enhance doctors' clinical reasoning through effective training. The aims were to develop and evaluate an intervention informed by decision theory to Improve doctors' reasoning about clinical judgements and decisions. A series of empirical studies were conducted to achieve these aims. A systematic review and questionnaire study were conducted to evaluate existing interventions that aimed to enhance doctors' clinical reasoning skills. There was little agreement between medical educators on how to effectively enhance doctors' clinical reasoning through training. However, the minority of interventions that aimed to improve doctors' awareness about their own reasoning processes were effective. Little is known about how to improve the processes doctors use to make clinical judgements and decisions in practice. A qualitative interview study was conducted to explore doctors' views and experiences of how to make effective clinical judgements and decisions. Doctors had limited explicit insight into their own reasoning processes, such as the methods that lead to good decisions and factors that bias their reasoning. A quasi-experimental. study was developed to evaluate the feasibility of an intervention to enhance doctors' understanding about their own reasoning processes. A brief tutorial was shown that explained the basic science underpinning human judgement and decision making. Doctors were receptive to learning about this information. They found it relevant to their clinical practice and gained knowledge about decision sciences concepts. Findings from this thesis suggest that, potentially, doctors can improve their clinical judgements and decisions through training to understand how they think about clinical problems.
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Bhan, Amrita. "Online Assessment-Enhanced Learning in Pre-Doctoral Orthodontic Clinical Decision Making." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/523103.
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Oral BiologyM.S.
Objectives: This pilot study aimed to determine the effect of the addition of an assessment to online course material on performance and self-efficacy of pre-doctoral students tasked with recognizing and diagnosing malocclusions on patients in the orthodontic screening clinic. Methods: Third year dental students completed an online module to reinforce concepts from the didactic curriculum prior to examining orthodontic patients. The experimental group (n=60) completed online case-based assessments before and after viewing an online module and then screened orthodontic patients. The control group (n=60) only viewed the online module prior to screening patients. The two groups were compared based on their average performance scores for diagnosis of various malocclusions, including but not limited to: dental developmental stage, crossbites, Angle molar classification, deep versus open bites, arch perimeter discrepancies, skeletal classification, and recommendation for orthodontic management. Additionally, differences in self-efficacy were assessed using a 5 question survey before and after screening orthodontic patients. Orthodontic residents were calibrated twice to ensure inter-rater reliability of student performance. Results: Performance: Results of a t-test showed a statistically significant increase in total assessment score in the experimental group when compared with the control group (p=0.047). Three out of ten questions had statistically significantly higher mean scores in the experimental group compared to the control group: vertical bite dimension (p=0.004), crowding and spacing in the mandibular arch (p=0.049), and vertical skeletal type (p=0.023). Self-Efficacy: The mean self-efficacy scores increased after completion of clinical requirements in both groups, with a pre-screening mean of 3.39 (SD=0.64) and post-screening mean of 4.39 (SD=0.41) in the control group and a pre-screening mean of 3.08 (SD=0.56) and post-screening mean of 4.28 (SD=0.37) in the experimental group. The self-efficacy scores were lower in the experimental group overall. The increase in self-efficacy was greater in the experimental group. Conclusions: The assessments added to online course content in this pilot study produced a statistically significant improvement in overall performance scores. Students demonstrated improved performance in the areas of diagnosis of vertical bite dimension, vertical skeletal type, and crowding and spacing in the mandibular arch. This study illustrates that the addition of an assessment to online course content could improve student learning outcomes related to diagnosis of dental and skeletal malocclusions and arch perimeter discrepancies. This pilot study shows that the addition of an online assessment lead to a greater improvement in self-efficacy scores. The addition of an online assessment also lead to lower self-efficacy scores overall. Qualitative follow up suggests that the students in the experimental group were more aware of the gaps in their knowledge. The creation of online assessments by orthodontic faculty can be used to overcome the faculty shortage in the field.
Temple University--Theses
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Xu, Hua S. M. Massachusetts Institute of Technology. "A system approach to augment clinical decision-making using machine learning." Thesis, Massachusetts Institute of Technology, 2019. https://hdl.handle.net/1721.1/121803.
Full textAbstract:
Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, System Design and Management Program, 2019Cataloged from PDF version of thesis.
Includes bibliographical references (pages 76-80).
This thesis helps find limits within which automated methods can support and surpass the capabilities of medical professionals and the limits beyond which these methods are not yet adequate. This will inform later exploration about (a) what improvements in data collection, interpretation, and visualization will enhance technology's capacity and (b) what changes clinicians can make to improve their decision making-augmented or not. This thesis includes (a) describing clinical decisions, informed by literature and clinical case studies and (b) reviewing current capabilities of machine methods. This led to (c) a test experiment-how to use data about a particular condition (e.g. in-hospital mortality rate prediction) from a particular source (the MIMIC III data base). The results will help define current limits on augmenting clinical decisions and establish direction for future work including more demanding experiments.
Artificial Intelligence (AI) includes Machine Learning (ML), Natural Language Processing (NLP), Computer Vision, Speech Recognition, and Robotics. As an important branch of Al, ML builds statistical models to learn from sample data, known as "training", identifies patterns, and makes predictions based on new data, known as "inference." In this way, ML is useful in rationalizing and predicting in uncertain environments, with minimum human interventions. Decision making is central to the healthcare practice, with many decisions made under conditions of uncertainty. Clinicians must integrate a huge variety of data while pressured to decrease diagnostic uncertainties and risks to patients. Deciding what information to gather, which test to order, how to interpret and integrate this information to draw diagnostic conclusions, and which treatments to give are essential.
In typical situations, clinicians evaluate patient symptoms and potential disease patterns, confirmed by a variety of tests, and they initiate treatments based on their experience and customary practice. This is complicated when multiple illnesses coexist, the illness may be rare, the information may be conflicting, or prior interventions may affect the presenting symptoms.
by Hua Xu.
S.M. in Engineering and Management
S.M.inEngineeringandManagement Massachusetts Institute of Technology, System Design and Management Program
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Parmley, Meagan Carleton Herbert James D. "The effects of the confirmation bias on diagnostic decision making /." Philadelphia, Pa. : Drexel University, 2006. http://hdl.handle.net/1860/1164.
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